Health Care Use And Spending Patterns Vary By Wage Level In Employer-Sponsored Plans

Employees face an increasing financial burden for health services as health care costs increase relative to earnings. Yet little is known about health care utilization patterns relative to employee wages. To better understand this association and the resulting implications, we examined patterns of health care use and spending by wage category during 2014 among 42, 936 employees of four self-insured employers enrolled in a private health insurance exchange. When demographics and other characteristics were controlled for, employees in the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1, 000 versus 17 per 1, 000), more than four times the rate of avoidable admissions (4. 3 individuals per 1, 000 versus 0. 9 per 1, 000), and more than three times the rate of emergency department visits (370 individuals per 1, 000 versus 120 per 1, 000) relative to top-wage-group earners. Annual total health care spending per patient was highest in both the lowest-wage (4, 835) and highest-wage (5, 074) categories relative to the middle two wage groups (3, 952 and 3, 987, respectively). These findings provide new insights about wage-associated variations in health care use and spending in employer-sponsored plans. For policy makers, these findings can inform employer benefit design strategies and research priorities, to encourage effective use of health care services.